In addition, Novant Health has appealed a decision by the Division of Health Service Regulation, which administers the state's certificate of need law, to withdraw a 2008 certificate for a new PET/CT scanner at Forsyth Medical Center due to lack of progress. Novant is seeking the reinstatement of the earlier approval.

Regarding the more recent decision, the two health systems filed competing applications for the positron-emitting tomography scanner in May after the State Medical Facilities Plan identified the need for one additional PET scanner in Forsyth County.

Each system was seeking a certificate of need from the state for the scanner, with each proposed project carrying a price tag of about $1.6 million. The state's certificate of need law is designed to avoid the unnecessary duplication of services and equipment to help control health care costs.

But state regulators found both applications lacking and denied them last month, leaving the systems the option of appealing to the state Office of Administrative Hearings.

Wake Forest Baptist is seeking to repurpose an existing PET scanner now being used on its main campus for research for clinical purposes. In denying the application, Project Analyst Gloria Hale said that the system had overestimated how much the scanner would be put to use in a clinical capacity at its main campus.

"We have decided to appeal the denial of our application as we believe our need to add a second clinical PET scanner is vital to support projected future growth in both Alzheimer's and cancer programs at Wake Forest Baptist Medical Center," said Jennifer Houlihan, director of planning operations for the medical center.

Houlihan said the medical center plans to work with the state to address their concerns, and she believes the application will ultimately be approved.

Novant Health had proposed to purchase a new scanner to install at its new cancer center at Kernersville Medical Center.

In denying the application, Hale wrote that Novant Health had received conditional approval for a new fixed PET scanner at Forsyth Medical Center but as of this fall, had not moved forward with plans to purchase that scanner and put it to use.

Based on its inaction on the earlier PET scanner project, "the applicant does not adequately demonstrate the need to acquire the proposed PET scanner," Hale wrote.

Novant Health spokeswoman Jeanne Mayer said that the addition of a PET scanner in Kernersville is a logical extension of the cancer services the health system offers there.

"Our cancer program at Kernersville Medical Center is continuing to expand, and in September 2013, we began offering radiation oncology services," Mayer said. "We believe a PET scanner is needed at Kernersville Medical Center to meet the needs of patients in that area."

Regarding the 2008 CON, Mayer said that this fall Novant submitted a progress report to the CON section of the state Division of Health Service Regulation that detailed how the project would be developed in 2014, and explained that funding the project "is a high priority."

Despite that, CON approval of the project was withdrawn by the state, Mayer said.

"We are optimistic that with the information we provided as part of our detailed progress report that the administrative law judge will be receptive and that we will be allowed to move forward with our plan to develop this project," Mayer said.